Endodontics · patient case question
What is the PERIAPICAL diagnosis (no abscess present)?
Patient case: Pregnant patient, third trimester — painful #19
Scenario: A pregnant patient in her THIRD TRIMESTER presents with pain on tooth #19. Cold testing produces LINGERING pain, and the tooth is TENDER TO PERCUSSION with a mirror handle.
Show answer and explanation
Correct answer: D. Symptomatic apical periodontitis
- A. A chronic apical abscess is characterised by INTERMITTENT DRAINAGE through a sinus tract and is typically asymptomatic; no tract is described.
- B. An acute apical abscess presents with rapid onset, swelling, and often systemic signs — the case explicitly states no abscess.
- C. Asymptomatic apical periodontitis is a radiographic apical radiolucency with NO percussion tenderness or pain; this patient is percussion-positive.
- D. Correct. TENDERNESS TO PERCUSSION indicates inflammation extending into the periodontal ligament — symptomatic apical periodontitis. It may exist with or without a radiographic periapical radiolucency.